Apparatus and related method to facilitate test via a computing device

ABSTRACT

This disclosure relates to a device to mechanically and electrically connect with a touch screen computing device, such as a tablet computer. The device can include a platform that can be moved into and out of physical contact with a surface of a touch screen. During engagement with the surface, the moveable platform electrically interacts with the touch screen (e.g., via capacitive coupling) to enable detection by the touch screen of contact members (e.g., pegs) even in the absence of user contact with the pegs.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation which claims priority to U.S. patentapplication no. 15/131,699, filed Apr. 18, 2016, which claims thebenefit of priority from U.S. Provisional patent application no.62/149344, filed Apr. 17, 2015, and entitled EXTERNAL MULTI-POINTTOUCHSCREEN APPARATUS, SYSTEMS AND RELATED METHODS OF USING, each ofwhich are incorporated herein by reference in its entirety.

TECHNICAL FIELD

This disclosure relates generally to a performance test for evaluationof neurological function, and more specifically to a system and methodthat can implement the performance test to evaluate a patient'sneurological and/or cognitive function.

BACKGROUND

Various diseases and disorders can adversely affect an individual'sneurological and/or cognitive function. For example, multiple sclerosis(MS) is a chronic, progressive disease of the central nervous system(CNS), in which the myelin sheaths of axons of the brain, spinal cordand optic nerve become damaged, resulting in an inflammatory response.MS can lead to demyelination and scarring, as well as a broad spectrumof signs and symptoms, which often progresses to physical and cognitivedisability.

MS-related disability ranges from minimal to severe, and evolution ofdisease manifestations over time is variable—both in the specific natureof the symptoms and disability and in the rate of deterioration. Thehistorical approach to measuring MS-related disability has been use of aneurologist rating scale, called the Kurtzke Expanded Disability Scale(EDSS). The EDSS rates disease severity using a 20 point scale, rangingfrom 0 to 10 in 0.5 point increments, with increasing numbers reflectingincreased disability. However, the EDSS has been criticized because itis neither precise nor quantitative. A newer approach has been toevaluate MS disease severity using a 3-part composite, called theMultiple Sclerosis Functional Composite (MSFC). The MSFC is athree-part, standardized, quantitative, assessment instrument for use inclinical studies, particularly clinical trials of MS. The MSFC canproduce scores for each of the three individual measures—walking,hand/arm control, and cognitive function—as well as a composite score.However, since the MSFC measures are administered in person by a trainedexaminer, its usefulness outside of clinical settings tends to beimpaired. Furthermore, current methods of executing examinations,including the MSFC, are manual, subjective and infrequent (only takingplace during a scheduled appointment). A need exists to provide a tooland procedure to more easily, more frequently and more objectively allowa user to undergo examinations and functional testing and in a mannerthat can collect and store data for future use, such as longitudinalcomparisons and population comparisons.

SUMMARY

This disclosure relates generally to an apparatus and related method tofacilitate testing via a computing device, such as can be utilized toadminister a test for the evaluation of cognitive and/or neuromotorfunction.

In one example, an apparatus includes a first housing portion comprisinga test fixture having a base dimensioned and configured to overlay atleast a display screen portion of a computing device. An arrangement ofreceptacles are formed in the test fixture and configured to receivecontact members within the receptacles. The test fixture is attached tothe computing device as to render each of the contact membersindependently detectable by the computing device while each respectivecontact member is received in the receptacles.

In another example, a mobile computing apparatus includes a computingdevice comprising a touch screen interface. The computing deviceincludes memory that stores instructions to perform at least one of aneurological or cognitive function test and to store results data foreach test in the memory. A test fixture is movably connected to thecomputing device. The test fixture includes a plurality of receptaclesconfigured for receiving at least one contact member that, when placedin the receptacles, interact with the touch screen interface as to bedetectable by the touch screen interface in the absence of directcontact by the user.

As yet another example, a method of using a mobile computing apparatusincludes providing a computing device having a touch screen interface.The computing device includes memory to store instructions correspondingto at least a manual function test module. The method also includesplacing a test fixture in a test position in which the test fixture isin an overlying position with the touch screen. The test fixture ispivotably connected to a base, which is attached to the computingdevice, and provides for rotational movement of the test fixture withrespect to the touch screen interface of the computing device betweenthe test position and a support position in which the base is operativeto support the base and the computing device. The test fixture includinga plurality of receptacles for receiving a plurality of contact membersthat, when placed in the receptacles while the test fixture is in thetest position, enable interaction that is detectable by the touch screenin the absence of direct contact by the user. The method also includesexecuting the manual function test module and storing test datacorresponding to user inputs in response to placing the contact membersinto the receptacles while the test fixture is in the test positionduring the execution thereof. The manual function test module can alsocalculate time values associated with the placing of the contact membersand store the time values as part of the test data.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts an example of a system that can implement a performancetest to produce results that can be used to evaluate a patient'sneurological and cognitive function.

FIGS. 2 and 3 depict examples of applications that can be used toproduce the results that can be used to evaluate a patient'sneurological and cognitive function.

FIG. 4 depicts an example of a manual performance test module that canbe used to evaluate a patient's manual dexterity.

FIG. 5 depicts a schematic example of an upper extremity test that canbe used to evaluate a patient's manual dexterity.

FIG. 6 depicts an example flow diagram demonstrating execution of amanual function test module.

FIG. 7 depicts an example of a cognitive processing speed test modulethat can be used to evaluate a patient's cognitive processing speed.

FIG. 8 depicts a schematic example of a cognitive processing speed testthat can be used to evaluate a patient's cognitive processing speed.

FIG. 9 depicts a screen shot of an example of cognitive processing speedtests that can be used to evaluate a patient's cognitive processingspeed.

FIG. 10 depicts an example flow diagram demonstrating execution of acognitive processing speed test module.

FIG. 11 depicts an example of a movement assessment test module that canbe used to evaluate a patient's center-of-gravity movement.

FIG. 12 depicts a schematic example of a mobile computing apparatus thatcan be attached to a patient for conducting one or more movementassessment tests to evaluate a patient's center-of-gravity movement.

FIG. 13 depicts another example of a movement assessment test modulethat includes a balance test module and a gait test module.

FIG. 14 depicts an example of a balance test module that can be utilizedto evaluate a patient's balance based on a center-of-gravity movement.

FIG. 15 depicts a screen shot of an example of part of a balance testthat can be implemented on a mobile computer to evaluate a patient'sbalance.

FIG. 16 depicts an example flow diagram demonstrating execution of abalance test module.

FIG. 17 depicts an example of a gait test module that can evaluate apatient's gait based on a center-of-gravity movement.

FIG. 18 depicts a schematic example of calculators that can be used bythe gait test module to evaluate a patient walking a predetermineddistance based on the patient's center-of-gravity movement.

FIG. 19 depicts an example flow diagram demonstrating execution of thegait test module.

FIG. 20 depicts an example flow diagram demonstrating execution of avisual acuity test module.

FIGS. 21-23 depict screen shots of examples of part of a visual acuitytest that can be used to evaluate a patient's visual acuity and/orsensitivity.

FIGS. 24-25 depict an example testing apparatus and housing that can beused to evaluate the patient's manual dexterity.

FIGS. 26A and 26B depict a portion of the housing of FIG. 25 .

FIGS. 27A-27E depict a hinge mechanism and associated connections forproviding the housing.

FIGS. 28A and 28B depict additional portions of the housing beingattached.

FIG. 29 depicts an example of a completed housing and associated tabletcomputer to provide a testing apparatus.

FIGS. 30A-33E depict alternative configurations for housings for thetesting devices described herein.

FIG. 34 depicts an example of different modules that can be part of amultiple sclerosis performance test (MSPT).

FIG. 35 depicts an example of a method related to performing testing forevaluation of cognitive and/or neuromotor function.

DETAILED DESCRIPTION

This disclosure relates generally to an apparatus and related method tofacilitate testing via a computing device, such as can be utilized toadminister a test for the evaluation of cognitive and/or neuromotorfunction.

By way of example, the apparatus is configured to attach to a tabletcomputing device for performing diagnostic tests on patients, such asmanual dexterity (e.g., peg test), cognitive and/or neuromotor tests.The device can include a moveable platform that provides a test fixtureconfigured to move into and out of physical contact with a surface ofthe touch screen of the computing device. In some examples, the platformis pivotably connected to the computing device, such as by a testfixture base that attaches the apparatus to the housing of the computingdevice. An arrangement of receptacles can be formed in the platform toreceive and retain contact members (e.g., pegs) within the receptaclesas to render the contact members detectable by the computing devicewhile received in the receptacles. For example, the receptacles can be atwo-dimensional array (e.g., a grid) of apertures extending through theplatform, which has a contact surface to mechanically and electricallyconnect the device with the computing device.

As a further example, the base can include a housing to surround orotherwise attach to a perimeter portion of the computing device toenable the platform to move into an overlaying contact test positionwith a predetermined portion of the screen. The platform further may bemoved away from the touch screen via the pivot (e.g., greater than about180 degrees of rotation about the pivot) to a support position in whichthe platform operates as kickstand to support the housing and thecomputing device when positioned on a surface (e.g., a table or desk).In some embodiments, the platform may be rotated around the tablet,flush with the other side so as to permit the user to lay the tabletflat on a surface. Thus, the platform, receptacles and touch screen canbe employed by a user to perform a manual dexterity test when in thecontact position, such as disclosed herein, and enable full access tothe touch screen when in the support position.

In some examples, the apparatus includes a hinge that pivotally connectsthe platform with respect to the test fixture housing, and the hinge canbe employed as part of an electrical circuit to provide an electricalpath between the receptacles of the platform with an electrical groundof the computing device. When the platform engages the touch screen(e.g., in the test position), the electrical connection that ismaintained between the receptacles and the chassis of the computingdevice enables the computing device (e.g., having a capacitive touchscreen) to detect the presence and absence of individual contact membersat each respective receptacle—with as well as without human contact withthe contact members. As a result, the computing device can be programmedto measure individual peg insertion and removal time (e.g., a part of amanual function and/or neuromotor test).

This disclosure also provides systems and methods that can be utilizedto implement a performance test to assess various aspects a patient'sneurological and cognitive function. The patient can have a neurologicalcondition that affects cognitive and motor performance, such as multiplesclerosis (MS) or other neurological disorders (e.g., Parkinson's,essential tremor, stroke, concussion, etc.). For example, theperformance test can be used to determine the severity of theneurological condition in the patient. Although the systems and methodsare described herein with respect to MS and the MS performance test(MSPT), it will be understood that patients with a neurological disorderother than MS can also benefit from the cognitive-motor performanceassessment described herein. Such testing can include preprogrammedtests that include use of the apparatus in conjunction with thecomputing device.

The approach assessing cognitive-motor performance according to thesystems and methods described herein can be easily implemented outsideof clinical settings by patients themselves or family members. Forexample, the systems and methods can be executed using a portablecomputing device, such as a tablet computer or smart phone, which isconfigured with one or more sensors, including, but not limited totimers, accelerometers and gyroscopes. The portable computing device canbe programmed to execute a set of test modules configured to assesscognitive-motor performance, such as a manual function test module, acognitive processing speed test module, and a movement assessment testmodule (and other test modules that can be used to assess thecognitive-motor performance). The set of modules can also include acollection module to aggregate test data from the manual function testmodule, the cognitive processing speed test module, and the movementassessment test module (as well as other test modules that can be usedto assess the cognitive-motor performance. The tests can be implementedto measure neurological function and/or neuropsychological function of asubject. For example, the tests can be employed as a test for MSseverity as part of a clinical trial or other research protocol, or forpatient monitoring for clinical assessment and care.

FIG. 1 depicts an example of a system 10 that can be employed fortesting and analysis of one or more patients. The system 10 can includeone or more computing apparatuses (also referred to as testingapparatuses) 12 programmed to execute a plurality of tasks based oninstructions stored in memory 14. The computing apparatus 12 can beimplemented in some embodiments as a portable computer, such as a tabletcomputer or smart phone. As such, the device may include a display/touchscreen 28 that provides a human-machine interface (HMI) that a user,such as a patient, can employ to interact with the computing apparatus12. As used herein a patient can refer to a living subject (e.g., adult,child or animal) in need of treatment by a physician, physicianassistant, advanced practice registered nurse, veterinarian, or otherhealth care provider or the subject may be a healthy subject that is tobe tested for other reasons.

In some examples, a user can perform a series of tasks that involvephysical interaction between the patient (e.g., using one or morefingers) and the touch screen 28 directly to manipulate one or moregraphical objects displayed on the screen. In other examples, user canperform certain tasks through interaction with an external input device32 that can be communicatively coupled with the system 10 (e.g., viaphysical or wireless connection with a corresponding port of theapparatus 12). The interaction may involve contact between the externalinput device 32 and the display 28 or otherwise be responsive to theinstructions and/or graphical elements presented on the display. Instill other examples, the apparatus 12 can include one or more sensors30 (e.g., one or more timers, accelerometers, gyrometers or gyroscopes)that can collect data in two or three dimensions responsive to patientmovement and interactions during selected tasks. By configuring thetesting apparatus (e.g., a tablet computing device) to perform aplurality of different test modules (e.g., stored in memory 14), theover testing process is facilitated for patients as well enablesrecording a rich set of test data for evaluation of cognitive andneuromotor function for such patients.

As an example, the sensor 30 can include one or more three-axisaccelerometers. The one or more accelerometers can be configured tomeasure acceleration of the apparatus along one or more axis, such as toprovide an indication of acceleration (e.g., an acceleration vector) ofthe apparatus in three dimensions. The one or more accelerometers canmeasure the static acceleration of gravity in tilt-sensing applications,as well as dynamic acceleration resulting from motion or shock.Additionally, the one or more accelerometers can possess a highresolution (4 mg/LSB) that can enables measurement of inclinationchanges less than 1.0°, for example. The one or more accelerometers mayprovide various sensing functions, such as activity and inactivitysensing to detect the presence or lack of motion, direction of motion,the smoothness of motion, and if the acceleration on any axis exceeds auser-defined level. The one or more accelerometers can also sensetapping (e.g., single and double taps) on a surface such as a touchscreen as well as sense free-fall if the device is falling. These andother sensing functions can provide output data. An exampleaccelerometer is the ADXL345 digital accelerometer available from Analogdevices. Of course other accelerometers could be utilized.

As another example, the sensor 30 can include a three-axis gyroscope(e.g., gyrometer) that can be configured to sense orientation of thedevice along three orthogonal axes. The gyroscope can provide outputdata corresponding to orientation of the apparatus 12 along threeorthogonal axes. The gyroscope can be implemented as 3-axis MEMS gyroIC, such as including three 16-bit analog-to-digital converters (ADCs)for digitizing the gyro outputs, a user-selectable internal low-passfilter bandwidth, and a Fast-Mode I²C (400 kHz) interface. The gyroscope30 can also include an embedded temperature sensor and a 2% accurateinternal oscillator. An example gyroscope that can be utilized is theITG-3200 3 IC available from InvenSense, Inc. Other gyroscopes could beutilized in other examples.

In the example of FIG. 1 , the system 10 can include input/output (I/O)circuitry 26 configured to communicate data with various input andoutput devices coupled to the system 10. In the example of FIG. 1 , theI/O circuitry 26 is connected to communicate with the display/touchscreen 28, the sensor 30, the external input device 32 and acommunication interface 34. For example, the communication interface 34can include a network interface that is configured to provide forcommunication with corresponding network 36, such as can include a localarea network or a wide access network (WAN) (e.g., the internet or aprivate WAN) or a combination thereof.

As a further example, the communication interface 34 can send task dataand/or analysis data derived from task data to a database 38. Thedatabase 38 stores test results data, such as obtained for a pluralityof patients (e.g., from one or more health institutions) based ontesting using any of the modules disclosed herein. For instance, thesystem 10 can be programmed to upload and transfer such data to theremote database 38, such as an electronic health record (EHR) for thepatient. Such transfer of data can be HIPAA compliant and provided overa secure tunnel (e.g., HTTPS or the like). The transfer of task dataand/or analysis data can be automated to occur upon completion of one ormore tests. Since the testing is performed via computing device (e.g.,tablet), the test results data can also include metadata associated withthe testing environment (e.g., time, geographic location, temperature orthe like) and the patient (e.g., demographic information, medicalhistory or the like) to facilitate analysis of patient data. Forinstance, the data provided by the apparatus 12 can further be analyzedby an external analysis system 39. The analysis system 39 can access thedatabase 38 directly (e.g., within a firewall where the database 38resides or it may access the database via the network 36 via a securelink. Results data acquired for one or modules for different patientcohorts can be aggregated together based on the testing metadata andassessed (e.g., by statistical processing) for a variety of purposes(e.g., clinical research and diagnosis).

A provider may also employ an EHR system or other interface to accessthe test results stored in the database 38. In this way, statisticalanalysis of a large patient population can be performed based on datacollected from a plurality of different apparatuses, which can bedistributed across a state, region, country or even the world. Moreover,since the set of tasks can be performed by patients using a portablecomputing apparatus (e.g., tablet computer, smartphone) 12 in theabsence of a trained healthcare professional, a single provider or teamof providers can monitor and service needs of a much larger patientpopulation than would otherwise be possible for traditional MS testing,which typically requires that each patient visit and travel to a testingsite for evaluation. Additionally, the approach disclosed herein canprovide a patient-centric neurological and neuropsychologicalperformance self-assessment system. By implementing such testing in thesystem as part of a self-administered testing platform, related scoringand analysis can be generated by the computer automatically because datais collected by such computer, obviating the need for human involvement,and allowing error-free score generation. Further the data collected isobjective and as accurate as the sensors and collection system thusproviding for more reliable data and statistics. As mentioned above, theanalysis and scoring can relate to evaluation of a patient'sneurological function, neuromotor function and/or neuropsychologicalfunction for the patient.

The computing apparatus 12 can also include a processing unit (alsoreferred to as processor) 16 and memory 14. The memory 14 can includeone or more non-transitory memory device configured to store machinereadable instructions and/or data. The memory 14 could be implemented,for example as volatile memory (e.g., RAM), nonvolatile memory (e.g., ahard disk, flash memory, a solid state drive or the like) or combinationof both. The processing unit 16 (e.g., a processor core) can beconfigured in the system for accessing the memory 14 and executing themachine-readable instructions. A user may enter commands and informationinto the computing apparatus 12 through one or more external inputdevices, such as the touch screen 28 or other user input devices (e.g.,a force transducer and stylus apparatus, pegs, microphone, a joystick, agame pad, a scanner, or the like) 32. Such external devices could becoupled to the computing system via the I/O circuitry 26.

By way of example, the memory 14 can store a variety of machine readableinstructions and data, including an operating system 18, one or moreapplication programs 20, other program modules 22, and program data 24.The operating system 18 can be any suitable operating system orcombinations of operating systems, which can depend on manufacturer andsystem to system. In some examples, the application programs and programmodules for implementing the functions of the test apparatus disclosedherein can be downloaded and/or updated and stored in the memory 14 forexecution by the processor 16. The application programs 20, otherprogram modules 22, and program data 24 can cooperate to provide motorand cognitive testing via the computing apparatus 12, such as disclosedherein. Additionally, application programs 20, other program modules 22,and program data 24 can be used for computing an indication of motor,cognitive or a combination of motor and cognitive functions of a patientbased on the task data acquired during testing, such as disclosedherein.

As a further example, the application programs 20 can be programmed toimplement a battery of tests designed to gather task data for evaluationof a patient's MS condition. For example, the system 10 can include thefollowing test modules programmed to collect data 24, including a manualfunction test module, a cognitive processing speed test module, a 9 holepeg test, and a movement assessment test module (and other test modulesthat can be used to assess the cognitive-motor performance). Themovement assessment test module can include one or both of a balancetest module and a gait assessment module. The data 24 can be analyzed tocharacterize the patient's cognitive and motor performance, individuallyor both simultaneously, to provide a quantitative assessment of thepatient's MS condition. The data 24 can be analyzed separately for eachof a plurality of individual tests to compute a score for each test.Additionally or alternatively, the data 24 for the set of tests can beaggregated to compute an overall score for the patient, which can alsobe stored in the memory 14 as part of the data 24. The analysis of thedata 24 can be performed at the apparatus 12, which is programmed toexecute such testing. In other examples, the analysis of the data 24 canbe performed remotely, such as by the remote system in response to thedata being uploaded from the apparatus 12 to the remote database 38.

Regardless of whether the analysis is performed by the apparatus 12, bythe remote analysis system 39 or a combination thereof, since theanalysis of the data can be performed by a computer according to testresults data, the analysis can provide a more robust characterization ofthe neurological, neuropsychological and cognitive functioning. As aresult, the approach disclosed herein can in turn ascertain more usefulinformation in distinguishing MS or other conditions from exceptednorms, and further distinguish severity within a condition and over timefor each patient, such as based on a historical analysis of test dataover period of time (e.g., one or more years). Additionally, such datacan be automatically entered into clinical or research databases,thereby eliminating the need for manual entry of data by a human, andallowing error-free data entry. Further, the data may be saved in aformat that makes longitudinal and/or population comparisons moreefficient.

FIGS. 2 and 3 depict examples of respective applications (e.g., storedin memory as machine readable instructions) 40, 50 that can be used toproduce the results test data that can be used to evaluate a patient'sneurological and cognitive function. Each of the applications 40, 50 canbe stored in the memory 14 of FIG. 1 and be executed by the processor 16of FIG. 1 , for example. The applications 40, 50 each include machinereadable instructions for an MS performance test (MSPT) andcorresponding data that can be programmed to test and evaluate MS statusand/or condition of a patient. The applications 40, 50 each includemodules that can employ a plurality of discrete tasks that capturecorresponding data.

In the examples of FIGS. 2 and 3 , the modules include a manual functiontest module 42, 52; a cognitive processing speed test module 44, 54; amovement assessment test module 46, 56; and a collection module 48, 58.The applications 40, 50 can also include one or more additional functiontest modules 47, 57. Application 50 also includes a scoring module 60.The manual function test module 42, 52 can evaluate a manual dexterityof a given patient in response to a first set of user inputs (FUI) basedon a manual dexterity test executed by the manual function test module42, 52. The manual function test module 42, 52 can store correspondingmanual dexterity test data (MDTD) in the memory based on the first setof user inputs (FUI) indicative of a measure of the given patient'smanual dexterity. The cognitive processing speed test module 44, 54 canevaluate a cognitive function of the given patient in response to asecond set of user inputs (SUI) based on a cognitive processing speedtest. The cognitive processing speed test module can store correspondingcognitive function test data (CFTD) in the memory based on the secondset of user inputs (SUI) indicative of the given patient's cognitivefunction. The movement assessment test module 46, 56 can evaluatecenter-of-gravity movement of the given patient in response to motiontest data (MTD) acquired during a physical activity (PAI) of the givenpatient. The movement assessment test module 46, 56 can store the motiontest data (MTD) in the memory indicative of the center-of-gravitymovement of the given patient. The collection module 48, 58 canaggregate test data (TD) based on the manual dexterity test data (MDTD),the cognitive function test data (CFTD) and the motion test data (MTD).The collection module 48, 58 can also aggregate data (AFTD) from anyadditional function test module 47, 57 into the test data (TD).

The modules of applications 40, 50 can execute tests (also referred toas tasks or trials) that provide outputs that can be utilized tocharacterize the cognitive and motor state of the patient. The tasks canbe programmed to provide and/or coordinate with a graphical userinterface (GUI) that displays graphics corresponding to the test. Themodules and/or tests can be programmed to collect data in response touser inputs and user interactions during the test. The data acquiredduring testing can vary based on the test being performed, the testmodule being executed, and the input devices activated to provide inputdata. The arrangement of this data and specificity can depend onapplication requirements and user preferences. Each of the applications40, 50 can sample active input devices for each test module and testcombination, along which related data (e.g., identifying timing, testID, module ID) to facilitate analysis thereof. The sample rate for agiven input source further can vary depending on the input deviceoperating parameters and the information being collected.

Examples of input data that can be collected can include clock data,accelerometer data, gyroscope data, GUI data, UI device data andanalysis data. The accelerometer data that can be acquired by samplingan output of one or more accelerometers (e.g., sensors 30 of FIG. 1 ) toprovide an indication of acceleration along one or more orthogonal axes.The gyroscope data can be acquired by sampling an output of a gyroscope(also referred to as a gyrometer). The GUI data can represent userinteractions received in response to user input (e.g., as can be madevia display/touch screen 28 of FIG. 1 ) during a respective test. Textand graphical objects can be visualized on a touch screen to instructthe user for performing the various tests for each respective testmodule. The GUI data can also include graphical and other informationthat is provided as part of the test and results of the test responsiveto user interactions. For example, the results and other information inthe GUI data can include timing information obtained during the test,based on a system clock (e.g., of the computing apparatus 12 of FIG. 1 )to provide timing information for when user inputs are received.Analysis and meaning attributed to the GUI data depending on the contextof the test and test module being executed can also be stored, such asforming part of the GUI data or the analysis data.

The data can also include user input (Up/device data that includes datacollected from one or more user input device (e.g., from external device32 of FIG. 1 ) during a respective test. For example, the user inputdevice can include a single axis or multi-axis force (torque) transducerthat can be utilized to measure a gripping force and associatedcoordination of a given patient under test. The device can be in theform of a cone-shaped or cylindrical structure to be gripped by the userand includes force transducer to measure the user's gripping force.Other force sensors may include, but are not limited to, the use ofsprings, strain gauges, piezoelectric materials, and electromagnetictransducers. In some examples, the gripping structure can be utilized toengage graphical objects presented on a display (e.g., a touch screen)via user interactions. The interactions can be detected via the touchscreen to provide corresponding GUI data. Thus, it is understood, thatthe input data recorded for a given test can involve more than one typeof data from one or more different input sources. In some example, theinput device can also include other sensors (e.g., accelerometers and agyroscope) such as to provide additional information associated withmovement of the gripping structure by the user during the test.Depending on the capabilities of the UI/device data and testrequirements, the UI/device data can also include other informationrelevant to tests or the test environment, such as timing information(e.g., timestamp applied to other data), temperature, altitude, userinputs received via user inputs at the device and the like. Thus, theinput data can include a combination of data from disparate and separatedevices (e.g., from a gripping device, clock, and from the touch screen)that can be utilized to perform each respective test. The type ofmovement and interactions requested can vary from test to test.

In the example of FIG. 2 , the analysis of the test data (TD) can beperformed by a remote analysis system, while in the example of FIG. 3 ,the analysis of the test data (TD) can be performed by a scoring module60 and a disability score(DS) can be provided to the remote database.The scoring module 60 can, for example, characterize the cognitive andmotor abilities of the given patient based on percentiles ofneurological normal function for the manual dexterity test data, thecognitive function test data and the motion test data. It will beappreciated that the scoring function and/or scoring module 60 can useanother means to determine the cognitive and motor abilities of thepatient with respect to neurological normative values that gives anunderstanding of the patient's disease state and/or progression.

The scoring module 60 can compute one or more score that can be used toevaluate the cognitive and motor abilities of the patient. The score canbe a score for a given test, such as implemented by each of the testmodules 52-58. In other examples, the score can be a combined scorebased on result data collected based on tasks executed for two or moreof the test modules. In yet other examples, individual tasks of a giventest can also be analyzed to compute a respective score. Each of thescores, regardless of the manner computed, can be stored in memory aspart of the analysis data. As mentioned, the scoring function can beprogrammed to compute each score automatically based on the test dataacquired by each respective test module. Scoring may also take intoaccount patient longitudinal date, i.e. data taken during similar testson the same patient during different sessions over a period of time.

Additionally, since each of the tests can be implemented according torespective test modules, each respective module can be updatedindependently as new data and testing paradigms might become available.Thus the MSPT application is scalable and extensible.

Examples of the manual performance test module that can be used toevaluate a patient's manual dexterity are shown in FIGS. 4-6 . FIG. 4depicts an example of a manual performance test module 62 that can beused to evaluate a patient's manual dexterity. FIG. 5 depicts aschematic example 70 of a standard nine-hole peg test that can be usedin conjunction with a touch screen computing device to evaluate thepatient's manual dexterity. FIG. 6 depicts an example flow of theexecution of a manual function test module 80.

FIG. 4 depicts an example of a manual performance test module 62 thatcan be used to evaluate the patient's manual dexterity. The user actionscan be prompted by graphical and/or audible indicators to initiate thetest. At element 64, the first set of user inputs can be received, eachin sequence, by the computing device (e.g., a tablet computer or a smartphone). The user inputs can be, for example, a touch by a user's fingeror a peg device to a touch screen or the mobile computing device. Atelement 66, the total time for the given patient to complete the firstset of user inputs can be calculated. Other parameters can also becalculated (e.g., force, time for individual tasks, and the like). Thetotal time (and other parameters) can be an output and/or a result ofthe manual function test module that is part of the test data and scoredby a scoring function.

FIG. 5 depicts a schematic illustration of an example implementation ofa testing apparatus 70 corresponding to a computer-implemented (e.g.,electronic) analog of a nine-hole peg test that can be used to evaluatethe patient's manual dexterity. A platform constituting a test fixture72 can be placed in a test position on a touch-sensitive screenhuman-machine interface of the testing apparatus (e.g., a tabletcomputer) 70. As disclosed herein, the test fixture 72 can be pivotablyconnected to a base of the apparatus 70, which is attached to thecomputing device, to provide for rotational movement of the test fixturewith respect to the touch screen of the computing device between thetest position and a support position in which the base is operative tosupport the base and the computing device. The test fixture 72 includesa plurality of receptacles (or holes) 74 a-i for receiving contactmembers that, when placed in the receptacles while the test fixture isin the test position, enable interaction that is detectable by thecomputing device even in the absence of direct contact by the user.

The test module (e.g., module 62 or 80) is also programmed to expose aGUI (based on executing preprogrammed MSPT instructions stored in memoryof the tablet computer there) on the touch screen 73 for instructing theuser during the test. The instructions, including graphical indicatorsat locations to place the contact members, can be viewable through thereceptacles and, in some examples, the test fixture. During testing, themanual function test module (module 62) stores the test datacorresponding to user inputs in response to placing the contact membersinto the receptacles while the test fixture is in the test positionduring the execution thereof. As mentioned, the test module calculatestime values associated with moving respective contact members from thestart position to the identified locations on the screen (predeterminedlocations that align with the receptacles), and stores the computed timevalues as part of the test data. The contact members can be electricallyconductive pegs (e.g., metal pegs) can be removed from startingreceptacles 78 a-i and inserted into the receptacles 74 a-i, and thetouch screen interface can detect when the pegs are in contact with thescreen.

Examples of testing apparatuses are disclosed herein with respect toFIGS. 24-33 . Other examples of a testing apparatus 70 that includes atest fixture 72 and contact members 78 that can be utilized inconjunction with a computing device having a capacitive touch screen aredisclosed in the above-incorporated U.S. patent application Ser. No.14/503,928 filed Oct. 1, 2014 and entitled OBJECT RECOGNITION BY TOUCHSCREEN, which published as US Pat. Pub. 20150094621 and is incorporatedherein by reference.

As disclosed herein, when a contact member (e.g., one of the conductivepegs) engages or otherwise is capacitively coupled with the surface ofthe touch screen (e.g., a capacitive touch screen) with or without humancontact, an electrically conductive circuit is established with thetouch-sensitive surface, which includes an electrical path from thecontact member to an electrical ground of the computing device. The pathcan establish a sufficient flow of electrons to enable the electricalcharacteristics (e.g., capacitance) of the touch-screen to change sothat the engagement can be detected even in the absence of humancontact. Since the contact member can be detected by the touch-sensitivesurface in the absence of contact by the subject, based on theelectrically conductive path that is established when a given peg isinserted into a receptacle of the test fixture overlying the touchscreen surface, each peg can be detected by the touch screen interfaceduring the test even after it is released by the user.

The manual function test module (e.g., module 62 or 80) can track datarelated to the nine-hole peg test, including, but not limited to: aposition of at least one peg, as well as various times, including thetime to complete the nine-hole peg test, a time for peg insertion, atime for peg removal, and/or a force used to insert or remove the peg.Pegs can have any shape such as elongated cylindrical members (e.g.,having circular or other cross-sectional shapes). In one example of thetest, the test is initiated with the pegs inserted in a row at thebottom of the screen, as demonstrated in FIG. 5 . Thus, each peg isdetected by the touch screen in the row, resulting in a graphicalindicator being displayed on the screen at the location corresponding toeach peg. The test ends when the user returns all of the pegs to theirstarting positions in the row. The timing for moving each peg from therow to one of the nine holes can be computed automatically by thecomputing device and utilized for assessing the manual dexterity of theuser.

In a second example of the test, designed to more closely simulate atraditional 9-hole peg test, the pegs are placed in the center bowl(such may reside between the test receptacles 74 and the startingreceptacles 78. The test ends after the pegs have been inserted into andremoved from all the wholes and all pegs are returned to the discardarea or starting position. Various instructions 75 can be visiblethrough the housing and/or adjacent to the housing (in an uncoveredportion of the screen 73) to help guide the user through one or moretests. Instructions can also be rendered as audio that can be providedvia speakers (e.g., external speakers of the device or headphonesconnected to an audio jack).

FIG. 6 shows example flow of the execution of the manual function testmodule 80 that can quantify manual dexterity during the performance ofan upper extremity task. The manual function test module 80 can includea plurality of sub-modules, each of which can include respectivefunctions. As shown in FIG. 6 , the sub-modules can include a setupmodule 82, a data collection module 84, a data processing module 86 anda data analysis module 88. FIG. 6 is described with respect to a tabletcomputer and the electronic analog of the nine-hole peg test of FIG. 5 ,but it will be appreciated that other mobile computing devices and/orother types of test can be implemented by the manual function testmodule 80.

The setup module 82 can facilitate setting up the manual function test,such as can include data 90 specifying that the housing of the nine-holepeg test has been positioned on the touch screen, which can beautomatically detected by the touch screen or in response to a userinput. Additional data setup data 92 can be provided to specify that thepegs of the nine-hole peg test have also been positioned to theirrespective starting position, which can be detected automatically or inresponse to a user input responding to query. In an example, the mobilecomputing device executing the test module 80 can be a tablet computer(e.g., an iPad tablet computer available from Apple, Inc. or anothercomputer having a touch screen interface). The housing of the testapparatus (housing 72 of FIG. 5 ; see also FIGS. 24-33 ) can bepositioned on the touch screen such that the holes in the housing cancorrespond to GUI input points on the touch screen. The pegs can bepositioned in a row or in the discard tray or adjacent storage containerdepending on the test process and configuration of the housing of thetesting apparatus. The pegs can be of a diameter smaller than thediameter of the holes, for example, to allow ease of fit, and a lengthgreater than the distance between the touch screen and the holes in thehousing, for example, to allow a user to place or remove a peg from thehousing.

The data collection module 84 can collect data related to the nine-holepeg test. The data collection module 84 can record a position of eachpeg (e.g., in the X and Y direction) on the screen 94. The datacollection module can sample the touch screen (e.g., via a touch screenAPI) for the detecting position data 96 representing a location each ofthe pegs at a predefined sample rate (e.g., about 60 Hz or a higher orlower rate). At each sampling interval, the time associated with anyinsertion and/or removal event of a peg can be recorded and stored inmemory as insertion or removal data 98.

The data processing module 86 can be configured to process input datafor subsequent analysis. For example, the data processing module caninclude a filter 100 to remove noise and artifacts from the collecteddata. For example, the filter can operate to remove artifacts due to“peg bounce” from data collected from the touch screen. The dataprocessing module 86 can also be configured to identify a phase shift102 from insertion of the peg to removal of the peg with respect to thetest fixture that is overlying the screen.

The data processing module can also include a timing monitor (e.g.,clock) 103 to track timing associated with data collected duringexecution of the test module 80. For instance, the timing monitor 103can determine factors, such as the total time to complete one cycle ofinsertion and removal of all 9 pegs. The timing monitor 103 for examplecan associate a time stamp to all input data, including position data 96from the touch screen and force information from a force transducer.Additionally, the timing monitor 103 can operate in conjunction with thetouch screen interface to indicate a time of insertion and removal ofeach peg relative to location and removal from the storage tray or homerow, and the difference in time to complete the tasks.

In another example, the data collection module 84 can include a forcecalculator 101 programmed to compute force during a series of tasks formeasuring the patient's manual dexterity. The manual function testmodule 80 can execute instructions, for example, to display a series ofGUI objects on a display with which the user is to interact by employingone or more gripping apparatus (e.g., the external user input device 32mentioned with respect to FIG. 1 ). As one example, the user can beinstructed to select an appropriate gripping device and move an end ofthe device into engagement with a GUI object displayed on the touchscreen. Different shapes and sizes of device can be used or a singlegeneric gripping device can be used. In addition to measuring grippingforce during the test, the force calculator 101 can compute othermovement and force related information (e.g., force variability) basedon the output of a force transducer with which the user interacts and/orinteraction with the touch screen. For example, detected data from theforce transducer can be communicated to the computer (e.g., via a wiredor wireless link) and the force calculator can convert the data in aforce measurement. The manual function test module 80 can also recordother test information, such as timing based on the timing monitor 103and other information attributes based on how the user moves thegripping device and how the user interacts with the touch screen duringeach task.

The data analysis module 88 can analyze the data and create the outputdata (e.g., MDTD) that is aggregated as part of the test data (e.g., TD)for future scoring. The data analysis module 88 can analyze one or moretime parameters 104. The time parameters 104 can include a total time tocomplete the test, an insertion time for a peg, and/or a removal timefor a peg. The time can also be computed as a time difference betweenany two sequential events. Statistical data (e.g., mean and standarddeviation) related to the time values can also be computed and stored inmemory. The data analysis module 88 can also measure a learning orfatigue effect 106 with the peg insertion or removal time, such as basedon an analysis of how timing changes between subsequent per insertionsand/or removals during execution of a given session of the manualfunction test module 80, such as when the same set of tasks is repeatedas part of the manual function test or if different tests are performed.

Examples of a standard cognitive processing speed test module that canbe used to evaluate a patient's cognitive processing speed are shown inFIGS. 7-10 . FIG. 7 depicts an example of a cognitive processing speedtest module 110 that can be used to evaluate a patient's cognitiveprocessing speed. FIGS. 8 and 9 depict a schematic examples screen shotsof interactive GUIs for cognitive processing speed tests 116 and 124,respectively, which can be generated on a touch screen by the cognitivetest module to evaluate a patient's cognitive processing speed. FIG. 10depicts an example flow diagram demonstrating the execution of thecognitive processing speed test module 130.

FIG. 7 depicts an example of a cognitive processing speed test module110 that can be used to evaluate a patient's cognitive processing speed.The cognitive processing speed test module 110 can include a symbolgenerator, a key generator, a timing monitor and an analysis function.At element 112, each input of a set of user inputs can be received. Theset of user inputs can be received from a user via a user interface,such as a touch screen of a mobile computing device (e.g., a tabletcomputer or a smart phone). At element 114, the time between each inputcan be determined. Also at element 114, whether the input is a corrector incorrect response to a prompt can be determined based on the userselection. The time and accuracy can be stored in memory. A score can bedetermined based on a number of correct responses in a time period for aspeed test trail. The number of correct responses during the time periodcan be aggregated as part of the test data (TD). Additionally oralternatively, the score can be evaluated relative to pre-test data(from a control group, longitudinal patient data, and/or acquired duringan un-timed pre-test).

As an example, overall test control can employ the cognitive speedprocessing test module 54 to implement a test (e.g., using the computingapparatus 12 of FIG. 1 ) to require that a user repeatedly associate asymbol (e.g., a digit 1-6 of FIG. 8 ) provided by the symbol generatorwith a random or pseudorandom key (e.g., S1-S6 of FIG. 9 ) generated bythe key generator. Examples of the different symbols that can beassociated with different numbers for the cognitive speed processingtest module are shown in FIG. 9 , depicts an example screen shot showinga GUI 124 for implementing a processing speed test.

As shown in FIG. 8 , the GUI can provide a key (e.g., randomlygenerated) and a sequence of characters that a user is to match duringthe testing 118. The randomly generated key can provide randomnumber/signal pairings for each administration. The participant recordsresponses by using the keyboard at the bottom of the screen 122. Themiddle section of the screen 120 is replaced with a new set a symbolswhen a response is recorded to the last symbol. The testing can recorddata indicative of both accuracy and speed for each phase of suchtesting. The processing speed test demonstrates comparable psychometricproperties as the more traditionally used symbol digit modalities test.

The cognitive processing speed test module 110 can also be programmed toprovide additional measures beyond simple measure of accuracy. Thetiming monitor can record the time to complete each task, the test awhole. The timing monitor can also be employed to supply a time base forinteractions during the test. For example, if the user is dragging agraphical object (e.g., with a finger or stylus), timing can be utilizedto compute acceleration and deceleration effects for such userinteractive dragging events. Other cognitive functions tested by thecognitive speed processing test module 110 can include memory recall,attention and mental fatigue.

FIG. 10 depicts an example flow of the execution of the cognitiveprocessing speed test module 130 that can be stored in memory andexecuted to evaluate a cognitive function of the given patient. Thecognitive processing speed test module 130 can include a plurality ofsub-modules, each of which can include one or more respective functions.As shown in FIG. 10 , the sub-modules can include a setup module 132, adata collection module 134, a data processing module 136 and a dataanalysis module 138. FIG. 10 is described with respect to a tabletcomputer and in the context of the corresponding symbol digit modalitiestest shown in FIGS. 8 and 9 , but it will be appreciated that othermobile computing devices and/or other types of tests can be implementedby the cognitive processing speed test module 130. Additionally oralternatively, a score can be determined which can be evaluated relativeto pre-test data (from a control group, longitudinal patient data and/oracquired during an un-timed pre-test).

The setup module 132 can present an instructional tutorial 140 on themobile computing device to establish test competency. The datacollection module 134 can collect data related to the cognitiveprocessing speed test. The data collection module 134 can record eachresponse with a time stamp 142, sampling for responsive inputs at asuitable sample rate (e.g., about 60 Hz or a higher or lower rate) 144.The responsive inputs can also be recorded with respect to testparameters 146 (e.g., key and symbol layout). The data processing module136 can include a time calculator 148 to calculate the time between theindividual input responses. The data processing module 136 can alsoinclude a function 150 to determine whether each individual inputresponse is correct or incorrect. The data analysis module 138 thus cananalyze the data and store corresponding output data (e.g., CPSTD) thatis aggregated as part of the test data (e.g., TD) for subsequent overalltest scoring. The data analysis module 138 can determine the total scorecorrect in the time period 152. The data analysis module 138 can also beprogrammed to identify any inter-trial learning or fatigue effect (andcorrect for these effects). Additionally or alternatively, a score canbe evaluated relative to pre-test data (from a control group,longitudinal patient data and/or acquired during an un-timed pre-test).

Examples of the movement assessment test module that can be used toevaluate a patient's center-of-gravity movement are shown in FIGS. 11-19. FIG. 11 depicts an example of a movement assessment test module 160that can be used to evaluate a patient's center-of-gravity movement.FIG. 12 depicts a schematic example 168 of a computing device (e.g.,mobile computer apparatus) 169 attached to a patient's body forconducting a movement assessment test. FIG. 13 depicts another exampleof a movement assessment test module 170 that includes a balance testmodule 172 and a gait test module 174. FIG. 14 depicts an example of abalance test module 180 that can evaluate a patient's balance based onmeasuring a patient's center-of-gravity movement. FIG. 15 depicts anexample 186 of a balance test that can be used to evaluate a patient'sbalance. FIG. 16 depicts an example flow of the execution of the balancetest module 190. FIG. 17 depicts an example of a gait test module 230that can evaluate a patient's gait based on a center-of-gravitymovement. FIG. 18 depicts a schematic example of calculators used by thegait test module 240 to evaluate a patient walking a predetermineddistance based on the patient's center-of-gravity movement. FIG. 19depicts an example flow of the execution of the gait test module 250.

In FIG. 11 , the movement assessment test module 160 includesinstructions executed to can evaluate a center-of-gravity movement ofthe given patient in response to motion test data acquired during aphysical activity (static or dynamic). The movement assessment testmodule 160 can receive accelerometer data (e.g., multi-axialaccelerometer data associated with a movement 162) and gyrometer data(e.g., multi-axial gyrometer data associated with the movement 164). Theaccelerometer data and gyrometer data can be sampled from anaccelerometer and gyroscope of the computing device and stored in memoryduring a respective task. The tasks can include a balance task (e.g.,provided by the balance test module 172 of the movement assessment testmodule 170 of FIG. 13 ) and/or a gait test (e.g., provided by the gaittest module 174 of FIG. 13 ).

To complete the tasks, the patient can wear or hold the portablecomputing device during a static test (e.g., balance test) or a dynamictest (e.g., gait test). For example, the movement assessment test module160 of FIG. 11 can be executed by a computing device 169 while attachedto the patient, such as demonstrated in FIG. 12 . FIG. 12 demonstrates amobile computing device (e.g., tablet computer or smart phone) 169 fixedon the patient's lower back at or approximating the sacral level. Forinstance, one or more straps or a belt 171 can be secured to the deviceand used to hold the computing device 169, for example, on the patient'slower back during execution of the movement assessment test module 160of FIG. 11 . In some further embodiments, the computer device may beattached, for example, with Velcro, snaps, buttons, pockets, elasticmaterial or ties. In some embodiments, the patient may hold thecomputing device. In some embodiments, the computing device may beattached to the head, back, chest, abdomen, arms and/or legs. Thistesting configuration can be used for both static testing (e.g., balancetest) and/or dynamic testing (e.g., gait test).

In FIG. 11 , at element 166, the center-of-gravity movement can becalculated based on the acceleration data and the gyrometer data for thepatient. The acceleration data and the gyrometer data can be acquired byone or more accelerometers and gyrometers in the computing device 169.An angular displacement can also be computed based on the gyrometerdata, which can be part of the center-of-gravity movement computed bythe test module 160 at 166. Movement assessment test module 160 can beprogrammed to translate the acceleration data and gyrometer data to thepatient's center of gravity based on placement of the computingapparatus at a predetermined position during execution of the testmodule 160.

FIG. 14 depicts an example of a balance test module 180 that can beconfigured to evaluate a patient's balance based on a staticcenter-of-gravity movement. The balance test module 180 can determine avolume of an ellipsoid in three-dimensional space corresponding to thecenter-of-gravity movement of the patient, demonstrated as function 182.A center-of-gravity movement during a static balance test corresponds toa lack of balance. The center-of-gravity movement is analyzed forbalance data under different conditions, demonstrated as function 184.An example of the different conditions is shown in FIG. 15 , whichdepicts an example screen shot 186 showing a GUI for one type of balancetest. In this example, instructions are provided to the user on how toimplement the test, such as can include plurality of tests for apredetermined duration. Data from sensors (e.g., one or moreaccelerometers, magnetometers and a gyroscope) can be collected duringeach test and a corresponding score can be computed based on suchresults.

FIG. 16 depicts an example flow of the execution of the balance testmodule 190 that can evaluate a balance function of the given patient.The balance test module 190 can include a plurality of sub-modules, eachof which can include respective functions. As shown in FIG. 16 , thesub-modules can include a setup module 192, a data collection module194, a data processing module 196 and a data analysis module 198. FIG.16 is described with respect to a tablet computer and the electronicanalog of the balance test shown in FIG. 15 , but it will be appreciatedthat other mobile computing devices and/or other types of tests can beimplemented by the balance test module 190.

The setup module 192 can position 200 the testing apparatus on thepatient's back and configure the time interval for the balance test(e.g., 30 second trials 202). The data collection module 194 can collectdata from the accelerometer 204 and the gyroscope 206, each sampled at,for example, 100 Hz. The data processing module 196 can normalize 208the data for initial apparatus orientation and placement, perform a lowpass filter 210 operation on the data, integrate 212 the gyroscope datato resolve angular displacement and calculate time-seriescenter-of-gravity (COG) movement 214 from accelerometer, gyroscope, andangular displacement data. The data analysis module 198 can analyze thedata and create the output data that is aggregated as part of the testdata (e.g., TD) for future scoring. The data analysis module 198 candetermine a 95% confidence interval (CI) of time-seriescenter-of-gravity movement per axis 216; a volume of an ellipsoid thatencompasses the 95% CI; a log normalized volume 220; and a per-axisanalysis for the effect of eyes open and eyes closed 222 conditions.

FIGS. 17 and 18 each depict examples of a gait test module 230, 240 thatcan be programmed to evaluate a dynamic condition (e.g., walking speedin a 25-foot walk test) for the patient. The evaluation can be based onthe accelerometer data and gyroscope data, which can be used in thecomputation of a walking speed, a cadence, a stride length, direction,and a variability in one or more of the other computed measures or othervariations that might be determined from the acceleration and gyroscopedata.

FIG. 17 depicts a gait test module 230 that can determine a volume of anellipsoid corresponding to a center-of-gravity movement of the patient232 and analyze the center-of-gravity movement for gait data underwalking conditions 234. The analysis can be completed using thecomponents of FIG. 18 , an efficiency calculator 242 and a qualitycalculator 244. The efficiency calculator 242 can compute a measure ofgait efficiency for each axis based on the center-of-gravity movementdetermined along each axis during a gait trial where the patient iswalking a predetermined distance. For example, efficiency can be basedon a comparison of a measure of movement in the direction of locomotionrelative to movement that is not in the direction of locomotion (e.g.,anterior-posterior versus medial-lateral motion), such as can be derivedfrom accelerometers and gyrometers attached to the patient duringtesting. The quality calculator 244 can compute a measurement of gaitquality for each axis based on the center-of-gravity movement determinedalong each axis during the gait trial and based on the time for thepatient to walk the predetermined distance. Gait quality, for examplecan be include efficiency as well as gait symmetry (e.g., a differentbetween left and right side motions) and jerk/accelerations that mightoccur during testing—also based on measurements from accelerometers andgyrometers attached to the patient during testing. Gait data can becompared against controls, patient populations and longitudinal patientdata.

FIG. 19 depicts an example flow of the execution of the gait test module250 that can include instructions executed to evaluate a dynamic motiontask of the patient. The gait test module 250 can include a plurality ofsub-modules. As shown in FIG. 19 , the sub-modules can include a setupmodule 252, a data collection module 254, a data processing module 256and a data analysis module 258. FIG. 19 is described with respect to atablet computer, but it will be appreciated that other mobile computingdevices and/or other types of tests can be implemented by the gait testmodule 250.

The setup module 252 can ensure that the apparatus is positioned on thepatient's lower back 260, establish parameters for a 25-foot walkingtrial 262, and set a duration dependent on time to complete the 25-footwalk. The data collection module 254 can collect accelerometer data 264(e.g., three dimensional accelerometer data from the apparatus) andgyroscope data 266 (e.g., three dimensional gyroscope data from theapparatus) both sampled at, for example, 100 Hz. The data collectionmodule 254 can also determine a time for the patient to complete the25-foot walk 268. The data processing module 256 can normalize 270 thedata for initial position (orientation and placement) of the apparatus,low pass filter the data 272, integrate 274 the gyroscope data toresolve angular displacement, and calculate the time-seriescenter-of-gravity movement 276 from accelerometer, gyroscope, andangular displacement data. As an example, the data analysis module 258can determine a 95% confidence interval (CI) of the time-seriescenter-of-gravity movement per axis 278, determine a volume of ellipsoidthat encompasses the 95% CI 280, log normalize the volume 282, andperform a per axis analysis for measure of gait efficiency and quality284.

An example of an additional function test module (e.g., module 47 inFIG. 2 or module 57 in FIG. 3 ) is a visual acuity test module. Thevisual acuity test module can include instructions programmed toevaluate visual function of the patient in response to user inputs,which can be stored in memory as the UI device data. The visual acuitytest module can include a contrast control such as to provide tests forboth static and dynamic visual acuity. For example a first part of testcan establish baseline static acuity data for the patient. Following thestatic visual acuity test, the contrast control can vary the contrast ina dynamic manner for a plurality of tests. The data between static anddynamic visual acuity can be analyzed to ascertain an indication ofpatient visual acuity. The data can include an accuracy level for thetest as well as a time to complete each phase of the test. Examples ofthe visual acuity test module that can be used to evaluate a patient'scenter-of-gravity movement are shown in FIGS. 20-23 . FIG. 20 depicts anexample flow of the execution of the visual acuity test module 290.FIGS. 21-23 depict schematic examples of a visual acuity test that canbe used to evaluate a patient's visual acuity.

FIG. 20 depicts an example flow that can include instructions executedby the visual acuity test module 290. The visual acuity test module 290can include a plurality of sub-modules, each of which can include one ormore respective functions. As shown in FIG. 20 , the sub-modules caninclude a setup module 292, a data collection module 294, a dataprocessing module 296 and a data analysis module 298. FIG. 20 isdescribed with respect to a tablet computer, but it will be appreciatedthat other mobile computing devices and/or other types of tests can beimplemented by the visual acuity test module 290.

The setup module 292 can set the screen to full brightness 301 andposition the apparatus 302 (e.g., 5 feet from the patient at eye level).The data collection module 294 can collect data regarding the line size,letters displayed, and gradient levels 303, as well as the number ofcorrect responses 305 recorded per line (e.g., of a possible 5). Thedata processing module 296 can determine a per line log MAR score 306that is calculated based on the line size and the score. The dataanalysis module 298 can determine the smallest readable letter at agiven gradient level 309. The smallest readable letter can be aggregatedas part of the total data (TD).

FIGS. 21-23 demonstrate examples of GUIs corresponding to differentvisual acuity tests that can be implemented for assessing a patient'svisual function. In the examples of FIGS. 21-23 different levels ofvisual contrast are provided, such as can correspond to 100% contrast,2.5% contrast and 1.25% contrast. Other levels of contrast can beprovided for testing a range of visual acuity. The testing can recorddata indicative of accuracy for the test as well as speed for suchtesting in response to user inputs indicating each respective letter viaa corresponding user input (e.g., keypad or keyboard).

FIGS. 24-29 illustrate an example testing apparatus 300 similar to thetesting apparatus 70 of FIG. 5 . The apparatus 300 includes a housingportion (e.g., constituting an enclosure) 370 for holding, storing, andtransporting a computing device 310 in a compact, reliable manner whilebeing lightweight and cost-efficient to produce. The computing device310 is programmed with instructions executable (e.g., by one or morehardware processor) to perform one or more test modules to evaluate apatient's condition that affects cognitive and/or motor performance,such as disclosed herein.

The housing 370 can be made by a number of different manufacturingtechniques including, but limited to, CNC, machining, die casting,extrusion, laser-sintering (rapid manufacturing), 3D printing, siliconecompression molding, thermoforming or laser-cutting and/or EVA foammolding. The housing 370 can be configured to be ergonomic anduser-friendly by, for example, including one or more handles extendingfrom the side(s) of the housing. The housing 370 should be easy and safeto carry while storing and protecting the computing device 310 and testfixture 370. For instance, the housing 370 can be formed from alightweight, durable material, such as a polymer or plastic. The housing370 can be translucent and may be clear or colored.

The housing 370 includes a base 332 and a platform constituting a testfixture 330. In the example of FIGS. 24-29 , the housing 370 has arectangular shape and extends from a first end 372 to a second end 374,which ends extend between and space apart opposing edges 375 and 376.The base 332 of housing 370 further can include lower and upper housingportions 381 and 382. The perimeter of the base 332 may be covered in arubberized material to facilitate gripping and increase the surfaceroughness along its perimeter. The housing 370 includes an interiorspace 378 for receiving the computing device 310 therein (see, e.g.,FIGS. 28A and 28B). One side of the base 332 includes a notch 380extending into the interior space 378. The platform 330 is pivotallyattached to the base 332 via a hinge 337 positioned within the notch 380to provide for rotation of the platform 330 with respect to the base 332and a computing device 310 attached within the base.

The platform 330 is sized and shaped to fit within and be readilyaccessed through the interior space 378 of the housing 370. Thisconstruction enables the platform 330 to pivot away from the computingdevice 310 and out of the interior space 378 by rotation of the platformin the direction R about the axis 338. As a result, the test fixture 330is movable relative to the computing device 310 between a testingposition overlaying the touch screen within the interior space (see,e.g., FIG. 29 ) and a support position extending out of the housing tosupport the apparatus when placed on a surface (see, e.g., FIG. 24 ). Inone example, the platform 330 can pivot through an arc of about 270°relative to the computing device 310 in the direction R. In otherembodiments, platform 330 can rotate up to 360° around the hinge to lieflat on the side opposite the screen or interface. The hinge 337 can bea friction hinge, such as biased by one or more springs 347 (see FIG.27E).

In some examples, such as shown in the example of FIGS. 24, 25, 26A and26B, the platform 330 may be T-shaped and include a perimeter 334. Acontact surface 339 of the platform 330 can be planar and have a shapeand size designed to fit within the interior space and onto the screen312 of the computing device 310 in an overlaying relationship, such ascorresponding to a testing position shown in FIGS. 25 and 29 (e.g., forimplementing a manual function test).

A plurality of receptacles 340 (demonstrated as 340 a and 340 b) areformed in the platform 330, such as such as to receive contact members(e.g., pegs) as disclosed herein. The receptacles 340 can be formed as aplurality of apertures extending through the platform 330 to provideaccess to the screen 312 of the computing device when the platform is inthe testing position to provide a corresponding test fixture. Theapertures 340 extend as apertures completely through the platform 332but, in other examples, alternatively can be blind, i.e., not extendentirely through the platform.

The receptacles 340 can be arranged in one or more predeterminedpatterns according to testing requirements. As shown in the examples ofFIGS. 24-29 , one set of receptacles 340 a are arranged in a 3×3 arrayof evenly spaced rows and columns. This configuration is similar oridentical to the apertures 74 a-i in FIG. 5 . The receptacles 340 a mayextend completely through the base 332 or partially therethrough to formreceptacles for receiving contact members therein. In some examples,another set of apertures 340 b extends into the base 332 and is arrangedin a predetermined pattern in an area spaced from the array of apertures340 a. As shown in FIG. 29, 9 apertures 340 b are arranged in a lineararray along an edge of the platform 330, with recesses extending betweenadjacent pairs of apertures. The receptacles 340 b can be similar oridentical to the shaded apertures shown in FIG. 5 and described herein.

By way of further example, the apertures 340 a, 340 b are configured toreleasably receive contact members (e.g., electrically conductive pegs)400 such as corresponding to the pegs discussed with respect to FIG. 5 .The pegs 400 can have any shape but are circular cylindrical in thisexample. Consequently, the receptacles 340 a, 340 b are likewisecylindrical. Different cross-sectional shapes of pegs and receptaclescan be utilized in other examples, such as for conducting differenttests. The apertures 340 a, 340 b can be countersunk or chamfered tofacilitate insertion of the pegs 400.

An interior sidewall of the apertures 340 a and 340 b can beelectrically connected to the housing of the computing device 310 via acorresponding electrically conductive material 342 a and 342 b thatextends from a location within the recesses between receptacles to thehinge 337, which is electrically coupled to electrical ground of thecomputing device 310. For example, the inner sidewall surface of thereceptacles includes electrically conductive material 342 to contactpegs that are insertable therein, which connects the pegs via acorresponding electrically conductive path in the recesses betweenreceptacles, which can include the hinge 337.

The hinge 337 further can complete an electric circuit betweenelectrically conductive sidewall portions of respective receptacles ofthe platform 330 and the housing of the tablet computing device 310. Asshown in FIG. 26A, for example, electrically conductive material 342 canbe provided as a sheet between the contact surface 339 and the opposingsurface 341 within the platform 330. The conductive material 342 caninclude apertures that align with each of the receptacles 340. Forinstance the conductive material 342 can extend along an interiorsidewall of the receptacles 340 a and 340 b, such as may be in the formof a bushing or other electrically conductive traces can be disposedalong an interior sidewall of the receptacles 340. The conductivematerial 342 can be electrically coupled to the hinge 337 via anarrangement of electrically conductive traces or wires 342 a disposed inthe body or along a surface of the test fixture platform 330. Since theconductive material at or near the sidewall of the apertures 340A iselectrically connected to the housing computing device 310, anelectrically conductive path can be established from the touch-sensitivesurface, through the sidewall, through the hinge to the housing of thecomputing device 310.

The hinge 337 also electrically connects the test fixture 330 to thecomputing device 310, such as by forming part of an electricallyconductive path. The path can establish a sufficient flow of electronsto enable the electrical characteristics (e.g., capacitance) of thetouch-screen to change so that the engagement between the contact memberand the touch screen can be detected even in the absence of humancontact. Since the contact member can be detected by the touch-sensitivesurface in the absence of contact by the subject, based on anelectrically conductive path that is established when a given contactmember is inserted into a respective aperture to contact thetouch-sensitive surface, each individual contact member can be detectedat a corresponding location during the test even after it is released bythe user.

FIGS. 27A, 27B, 27C, 27D and 27E illustrate an example of the hinge 337and other parts constituting the electrical path for connecting theplatform 330 to the chassis (electrical ground) of the computing device310. The hinge 337 includes a portion that is integrally formed with theplatform 330 and includes an electrical contact 341 electricallyconnected to the electrical conductive material 342 within theapertures. A terminal block 343 is positioned within the base 332 of thehousing adjacent the notch 380. The terminal block 343 is electricallyconnected to the computing device 310 via a terminal lead 351 andincludes an electrical contact 345. A spring 347 extends between thecontacts 341, 345 and electrically connects the same as well as providesmechanical bias for friction during rotation of the platform relative tothe base 332. The contacts 341, 345 and spring 347 are aligned along theaxis 338 of the hinge 337. Consequently, the spring 347 forms part ofthe path to establish electrical contact between the electrical groundof the computing device 310 and the test fixture 330. The housingshields the connection therein.

As shown in FIGS. 27D and 27E, an electrically conductive element (e.g.,a wire) 353 can be connected to the terminal lead 351 via a screw orother fastener (bolt, conductive adhesive, solder or the like). Theconductive element 353 can terminate in a plug 354 that is insertableinto an audio or other jack of the computing device 310 for completingthe path to electrical ground of the device (e.g., the jack includes adevice ground connection). In some examples, the conductive element 353can include a splitter 356 can be used to provide an additionalauxiliary jack 358 to enable use of the audio jack while the testingapparatus is in use. The jack 358 thus can be exposed and accessiblefrom external to the housing during operation.

FIGS. 28A and 28B demonstrate assembly views of the apparatus 300showing attachment between lower and upper housing portions 381 and 382.In FIG. 28A, the computing device 310 is positioned within the lowerhousing portion 381, such as within a receptacle dimensioned andconfigured to receive the computing device therein. In FIG. 28A, theplatform is rotatably attached to the lower housing portion 381 via thehinge, as mentioned above. In FIG. 28B, the upper housing portion 382 isplaced over the lower portion 381, such as to sandwich the computingdevice therein. The lower and upper housing portions can be connectedtogether via snap fit, adhesive, ultrasonic welding or the like toprovide the assembled apparatus 300, such as shown in FIG. 29 .

In use, the apparatus 300 is removed from a storage area and carriedto/placed on a table or surface. A soft protective cover (if applicable)is removed. The test fixture 330 is pivoted about the hinge 337 in thedirection R away from the touch screen 312 to access the entire touchscreen and initiate the desired test. When the test is ready, the testfixture 330 is pivoted about the hinge 337 in the direction R to aposition overlying the touch screen 312. This places the apertures 340 aand/or the apertures 340 b in positions overlying predetermined portionsof the touch-sensitive screen 312 (e.g., corresponding to the testposition). For example, the computing device can be programmed togenerate an interactive graphical user interface that includesinteractive GUI elements aligned with one or more of the apertures 340a, such as during a given test, such as disclosed herein. One or more ofthe pegs 400 can be removed from the aperture(s) 342 b or the chamber385 and inserted into one of the apertures 340 a, allowing the pegs toextend entirely through the base 332 into proximity with the touchscreen 312. The touch screen 312 detects and determines when any of thepegs 400 are in contact with the GUI.

The first end 372 of the upper housing portion 382 includes recessedchambers 384, 385 accessible by a door 386 that is pivotably connectedto the front of the housing 370. The chambers 384 and 385 can include aseries of parallel slots or other containing features, such as can beused for receiving and storing the pegs when not in use. The door 386can securely lock (e.g., snap-fit) with the remainder of the housing 370to ensure the door remains closed during storage, transport, andmanipulation of the apparatus 300.

Due to the construction of the hinge 337, the test fixture 330 can alsofunction as a leg or kickstand to support the housing and computingdevice 310 in a generally upright orientation without leaning againstanother object or the aid of a person. As shown in FIG. 24 , the testfixture 330 can be rotated in the direction R out of the interior space378 to a position extending behind the computing device 310. When theangle between the rotated test fixture 330 and housing 370 approaches,for example, 90°, the test fixture is released. The friction hinge 337maintains the desired angle between the rotated test fixture 330 andhousing 370 while the rubberized perimeter 334 on the base 332 grips thesurface on which the apparatus 300 is placed, e.g., countertop, tabletop, etc.

In some embodiments, the hinge may comprise a ratchet or a lockingdevice, such as a pin through the housing preventing rotation or amagnet, in addition to or in lieu of the friction fit. Consequently, theapparatus 300 has a desired viewing orientation for the user that ismaintained by the friction hinge 337 and increased friction between theperimeter 334 and contact surface, thereby facilitating reading thetouch screen 312. In some alternate embodiments the text fixture canswing fully around to and flush with the back side of the tablet(opposite the screen). This ability would allow a user to lay the deviceflat on its back on a surface.

As disclosed herein, the computing device 310 can be programmed to, suchas part of neuromotor test program, e.g., a manual function test, formeasuring individual peg 400 insertion and removal time in any of theapertures 342 a, 342 b, i.e., the 9 hole peg test (9HPT). In otherexamples, the same test program can include other test modules, such asfor testing visual acuity by holding the computing device 310 at thecorrect angle for performing the test, and performing a timed 25 footwalk.

In one testing example, such as for the door 386 is opened to access thepegs 400, which are removed from the chamber 385 and place in the row ofapertures 340 b in the test fixture 330. The pegs 400 are then moved byhand from the row of apertures 340 b to the grid of apertures 340 a,with instructions provided on the touch screen 312. The user can accessa help button (not shown) on the computing device 310 if needed duringthe test. To this end, portions of the touch screen 312 can beaccessible by the user while the test fixture 330 overlies the touchscreen. Moreover, the test fixture 330 can be transparent to enableviewing of the touch screen 312 through the downwardly pivoted testfixture.

Once the test is completed, the pegs 400 are placed back into thechamber 385 and the door 386 closed. The test fixture 330 is pivotedaway from the touch screen 312 to complete any remaining tests. Uponcompletion of all tests, the test fixture 330 is again pivoted to aposition overlying the touch screen 312. The protective cover isreplaced and the apparatus 300 carried back to storage.

The housing 370 is advantageous in that it helps protect both thecomputing device 310 and the test fixture 330. The housing 370 issemi-permanent and covers/protects nearly the entire computing device310, aside from the touch screen 312, which remains at least partiallyaccessible. The housing 370 also maintains easy access to the powerbutton 390 and provides a convenient means of storing the pegs 400 whennot in use.

The periphery of the housing 370 is advantageously provided withnotches, openings, etc. (not shown) to maintain access to all ports andbuttons on the computing device 310 when stored therein, e.g., headphonejack, volume buttons, USB port, etc. For instance, the splitter 356 maybe provided to enable the patient to listen to audio instructions whilesimultaneously performing the prescribed test(s). The splitter 356 canconstitute an off-the-shelf splitter, a custom OEM external splitter oruse connectors and wire assemblies built into the housing 370.

As a result, the housing 370 provides a protective cover for thecomputing device 310 that allows the computing device to be usedefficiently with the manual dexterity test and any other assessment orquestionnaire deliverable via the computing device. The patient cantherefore readily listen to and/or visually see instructions provided bythe computing device 310. The housing 370 can also be made ergonomic tofacilitate grasping, manipulation, and feel for the patient.

FIGS. 30-33 illustrate alternative configurations for housings to beused with the test fixture 330 and computing device 310 describedherein. In FIG. 30 , the housing 470 is a sliding type in which thecomputing device 310 is laterally slid into the interior space 474 ofthe housing. The housing has a U-shaped sidewall 472 defining theinterior space 474 and including a series of recessed portions 473contoured to the shape of the computing device 310. The computing device310 is slid laterally into the interior space 474, sliding along therecessed portions 473. The contour of the recessed portions 473 helpsretain/lock the computing device 310 within the housing 470. The testfixture 330, which is shown with a generally rectangular configuration,can be secured to the computing device before or after the computingdevice is slid into the housing 470 or afterwards. The housing 470 caninclude a handle 480 at the open end of the sidewall 472 (or any otherplace along the sidewall) for grasping/manipulating the apparatus.

In FIG. 31 , the housing 570 has a drop frame configuration having arectangular sidewall 572 defining an interior space 576. A recess 574extends into portions of the sidewall 572 to form a ledge that receivesthe computing device 310 and test fixture 330. One or more feet 580 canbe secured to the bottom of the housing 570. A splitter 600 forheadphones can be connected to the computing device 310.

Similarly, in FIG. 32 , the housing 670 has a deep drop frameconfiguration having a rectangular sidewall 672 defining an interiorspace 676. A recess 674 extends into portions of the sidewall 672 toform a ledge that receives the computing device 310 and test fixture330.

FIG. 33 illustrates a housing 770 for a computing device 310constituting a lap top. The housing 770 includes a rectangular sidewall772, a handle 780 extending from the sidewall, and an interior space 776for receiving the computing device 310. A panel 774 secured to the frame772 pivots in the direction R to more fully enclose the computing device310 within the interior space 776—for protection—or to access theinterior space.

Routine collection of clinical data from neurological assessments isimpaired by the requirement for qualified staff to administer tests andrecord the data in a consistent and timely manner. Collection andaggregation of this data over time is important in assessing diseaseprogression and response to treatment in MS patients, as reflected inthe widespread use of the traditional forms of these neurologicalassessments in clinical trials. The apparatus disclosed herein allowsthe patient to self-administer neurological tests that are widelyaccepted by the neurological community, yet not routinely used inclinical practice due to time and resource constraints.

The immediate need for this design is therefore to allow a reduction inclinical staff required to administer functional tests, which isaccomplished by having largely self-administered tests. The autonomousnature of the apparatus would also allow for use by patients that areambulatory, e.g., in-home assessment by the patients themselves. Thiswould allow for greater resolution in functional data when makingclinical decisions. By reducing the workload on the clinical staff, agreater amount of data can be captured for each patient. Theavailability of this data to clinical staff will enhance the care of MSpatients by providing routine, quantitative measures of function thatare currently not captured. Further, acquisition of data by a computerbased system allows for more reliable, standardized and objective dataand easier storage, retrieval and analysis of the data, includinganalysis with respect to patient populations and longitudinal data.

In view of the foregoing, it will be appreciated that the data collectedvia the approach disclosed herein provides facilitates automatedassessment of a plurality of tests. For example, the approach provides apatient-centered neurological performance system, it can be used innon-medical setting (autonomously by the patient at home or other remotelocation) as well as medical settings typically not equipped to providecertain types of healthcare, such as at rural hospitals. The datacollected for each given patient for a test sessions can be used forpatient evaluation as well as for management of the patient's condition.Additionally, since the cost of the test system is inexpensive comparedto many existing systems, the systems and methods disclosed hereinfacilitate clinical research projects, including clinical trials.

The testing can be implemented, for example, via a tablet computer, andcan employ a graphical user interface on a portable computing device toimplement one or more neurological and neuropsychological performancetest method. For instance, the test method(s) can be utilized to helpcharacterize a patient's multiple sclerosis or other neurologicaldisorder (e.g., Parkinson's or essential tremor). As disclosed herein,the method can be self-administered by the patient himself/herself (asopposed to traditional clinician supervised testing which needs to bedone by a trained technician). Thus the approach disclosed hereinfacilitates distance-based monitoring such as through telemedicine.Additionally, since the testing can be self-administered, it enables acare provider (e.g. a physician) to monitor the patient's condition overtime to determine the course of disease and the effect of interventionfor each of a plurality of patients.

The care provider can access a database to retrieve test results for aplurality of different patients that conducted the test at differentremote locations, via a tablet computer where a test was implemented ora remote computer (e.g., smart phone, desktop PC or the like). As afurther example, the test results can be communicated to one or moreproviders. This can be done by simply reviewing the results on thecomputing device or the results can be sent to the provider(s) via anetwork connection, as disclosed herein. The test results for one ormore subjects, for example, can be stored in a database in a server forfurther analysis and comparison. For instance, test data can beaggregated for a plurality of patients, such as for clinical research(e.g., in MS), including clinical trials and other forms of clinicalresearch. Such test results for multiple tasks completed over adifferent time intervals (e.g., over a period of a day or a given week)can be evaluated to set one or stimulation parameters.

As will be appreciated by those skilled in the art, portions of thedevices, systems and methods disclosed herein data processing system orcomputer program product. Accordingly, such features may take the formof an entirely hardware embodiment, an entirely software embodiment, oran embodiment combining software and hardware. Furthermore, portions ofthe invention may comprise a computer program product on acomputer-usable storage medium having computer readable program code onthe medium. Any suitable computer-readable medium may be utilizedincluding, but not limited to, static and dynamic storage devices, harddisks, optical storage devices, and magnetic storage devices.

FIG. 34 shows an example of various testing modules of an example MSPTassessment system 820. For example, the modules can include a treatmentmodule 822, a quality of life module 824, a processing speed module 826,a manual dexterity module 828, a contrast sensitivity module 830, and awalking speed module 832. The modules can be implemented according tothe examples disclosed herein with respect to FIGS. 2-23 . Results ofthe MSPT can be visualized on the display 834. Additionally, aspects ofeach of the modules 822-830 can be displayed on the display 834 in auser-interactive manner. For example, the display 834 can be an inputdevice, an output device, and/or an input/output device that can allow auser input and/or a resulting visualization. In some examples, thedisplay can be part of a computing device that includes one or moreprocessing unit and memory, which can execute instructions correspondingto the modules 822-830 and store data in the memory to document resultsof user interactions and measurements via the respective modules.

As an example, the treatment module 822 is stored in memory asexecutable instructions to provide one or more questionnaires, such as aquestionnaire related to upper extremity function, a questionnairerelated to lower extremity function, a questionnaire related to sleep, aquestionnaire related to fatigue, a questionnaire related to anxiety, aquestionnaire related to depression, a questionnaire related to stigma,a questionnaire related to positive affect and well being, aquestionnaire related to applied cognition, a questionnaire related toexecutive function, a questionnaire related to the ability toparticipate in social roles, a questionnaire related to satisfactionwith social roles, and/or a questionnaire related to emotional andbehavioral dyscontrol. A score can be provided per question as aninteger value indicating the patient's response (e.g., 1 Never, 2 Almostnever, 3 Sometimes, 4 Often, 5 Almost always).

The quality of life module 824 is stored in memory as executableinstructions to ask patients (e.g., in a graphical fashion via a GUI) torate their quality of life for various questions related to neurologicalfunction. The questions can be broken into sub-tests based on domains offunction that can include, for example: upper extremity, lowerextremity, sleep, fatigue, anxiety, depression, stigma, positive affectand well being, cognitive function, satisfaction with social roles, andemotional and behavioral dyscontrol. The sub-tests can be independentfrom each other and may be administered serially with the results notaffecting subsequent tests. A score can be provided per question as aninteger value indicating the patient's response (e.g., 1 Never, 2 Almostnever, 3 Sometimes, 4 Often, 5 Almost always).

The processing speed module 826 is stored in memory as executableinstructions to provide a symbol-digit matching test in which subjectscan be given an answer key, displaying correct symbol-digit pairings.Then the subject can be presented with symbols and blank spaces beneaththem and can be required to select the number that corresponds with eachsymbol based on the answer key. The test can be scored based on thetotal number of correctly matched symbol-digit pairs in two minutes. Insome instances, the score can be additionally based on the response timeper symbol and the number of incorrect responses.

The manual dexterity module 828 is stored in memory as executableinstructions to enable user interaction with the testing apparatus byallowing patients to manipulate physical pegs into a grid overlay withtheir dominant hand and their non-dominant hand in sequence (e.g., 2trials per hand, 60 seconds per trial). The module 828 can correspond tothe manual function test module disclosed with respect to FIGS. 4-6 .This test can be implemented using any of the example housings disclosedherein, such as demonstrated in FIGS. 24-33 with corresponding graphicsappearing on the touch screen through the test fixture (e.g.,constituting a grid overlay) of the testing apparatus with instructionsthat specify which hand to use during each trial. A score can becalculated based on the number of pegs correctly placed, a time to placethe pegs, a number of pegs dropped, and the like. For example, time toplace pegs can be calculated as the time between the touch screeninterface detecting removal of a peg from its starting position andinsertion of the given peg into the correct peg hole In some examplesthe manual dexterity test can be implemented (e.g., including with thehousing and pegs of FIGS. 24-33 ) according to a workflow correspondingto instructions executed by the tablet computer of the testingapparatus.

The contrast sensitivity module 830 can apply a low contrast visualsensitivity test such as disclosed herein. In some examples, thecontrast sensitivity module 830 can apply the low contrast letter acuitytest, which can show the patient lines consisting of a plurality ofdifferent optotypes (e.g., about 5 optotypes) of a fixed contrast leveland size. Additionally or alternatively, the

The walking speed module 832 can have functionality to enable patientsto measure the time it takes for them to walk a specified distance. Ascore can be based on the time taken to walk the specified distance. Inthis module 832, a patient performs tests to measure the time it takesfor them to walk a specified distance. Prior to starting any trials, apatient may first answers questions provided by the tablet computingdevice, regarding their utilization of any walking aids or Ankle andFoot Orthoses (AFOs) usage. Once these questions are answered, thepatient is presented with instructions instructing them how tosuccessfully complete the module. Part of the instructions is testingthe Low Energy Bluetooth (LE-BT) remote to ensure it is properly pairedto the device. Other possible remote triggers include infrared, NearField Communications, sound activation, light or laser activation,motion sensors, force sensors, accelerometers and so forth.

After the instructions, the test phase begins. The patient makes theirway to a prescribed testing course. Once at the starting line, theypress the remote once to begin the trial. Upon crossing the finish line,they press the remote again to stop the trial. The patient then returnsto the device to confirm that the trial was complete successfully. Inthe event the trial was not successful, the patient has the ability torepeat the trial. Repeating a trial stores the previous trial data butmarks it as invalid. The patient repeats this cycle for every trial thatis administered.

An alternate administration method may involve an administrator or otherperson (e.g., friend or family member) tapping the iPad screen to startand stop a trial; this is to be used in place of or in conjunction withthe LE-BT remote. The method of starting and stopping a trial will berecorded. In the event that a trial reaches maximum duration, the trialmay be scored as having the maximum time and stored as successfullycompleted with a TIMEOUT=TRUE flag.

The apparatus and computing device enable one or more of such tests tobe readily self-administered by the subject, as opposed to by a trainedtechnician; however, a trained technician can also administer suchtests, if desired. This is enabled because the application of each testmodule and associated score scoring is automated by executableinstructions programmed to process acquired testing data and to scoretests based on testing data acquired during each of the tests by thecomputer via which the tests are administered. In some examples, thedata from these tests can be aggregated at the computing device andtransmitted to a provider database via a network. This process orsending the test data can also be automated. The test data can becollected (e.g., in a database) for many patients for a variety ofevaluative purposes, such as to facilitate patient monitoring, providepopulation statistics, and drug development.

As an example, the tests and associated instructions can be stored andexecuted on a server (e.g., database 38 of FIG. 1 , such as on a webserver) and accessed at another remote device (e.g., a computing device)for user interaction, such as via a web browser or other interface thatis programmed to interact with the user interface that is generated. Insome cases, the functionality can be distributed between the server andthe remote device in which certain instructions are executed by theremote device and other instructions are executed by the server. Inother examples, the instructions and data can be stored and executedlocally in a computing device (e.g., a portable or mobile device), suchas a tablet computer.

FIG. 35 is a flow diagram depicting an example of a method 900 forperforming testing for evaluation of cognitive and/or neuromotorfunction, such as for the MSPT. The method 900 can be implemented usinga mobile computing apparatus, such as disclosed herein. The methodbegins at 902 by providing a computing device having a touch screeninterface. The computing device includes memory to store instructionscorresponding to at least a manual function test module (e.g., 62, 80,828). As disclosed herein, the computing device can be used to storeinstructions to perform other test modules, including one or more of acognitive processing speed test module (e.g., 110, 130 and/or 826), agait test module (e.g., 230, 240, 250, 832), a balance test module(e.g., 160, 170, 190), and a visual acuity or contrast sensitivity testmodule (e.g., 290, 830).

At 904, the method includes placing a test fixture (e.g., platform 330)in a test position in which the test fixture is in an overlying positionwith the touch screen (see, e.g., FIGS. 5 or 25 ). As disclosed herein,the test fixture is pivotably connected to a base, which is attached tothe computing device (e.g., 310). The connection provides for rotationalmovement of the test fixture with respect to the touch screen interfaceof the computing device between the test position (see, e.g., FIGS. 25and 29 ) and a support position (see, e.g., FIG. 24 ) in which the baseis operative to support the base and the computing device. The testfixture includes a plurality of receptacles for receiving a plurality ofcontact members that, when placed in the receptacles while the testfixture is in the test position, enable interaction that is detectableby the touch screen in the absence of direct contact by the user.

At 906, the method includes executing the manual function test moduleand storing test data corresponding to user inputs in response toplacing the contact members into the receptacles while the test fixtureis in the test position during the execution thereof. The manualfunction test module calculates time values associated with the placingof the contact members and store the time values as part of the testdata in memory.

At 908, a determination can be made whether the testing method iscomplete. If additional testing modules are to be performed, the methodproceeds to 910. At 910, the method further includes executing the nexttest module and storing other test data in the memory based on userinteractions with the computing device during the execution thereof. Inconnection with performing the additional testing, the user can movetest fixture from the testing position for the manual function test tothe support or another position to provide desired access to the touchscreen (e.g., the apparatus can lay flat or be supported by the testfixture acting as a kickstand). From 912, the method returns to 908. At908, if the determination is that the testing is complete, the methodends at 912.

Certain embodiments of the invention are described herein with referenceto flowchart illustrations of methods, systems, and computer programproducts. It will be understood that blocks of the illustrations, andcombinations of blocks in the illustrations, can be implemented bycomputer-executable instructions. These computer-executable instructionsmay be provided to one or more processor of a general purpose computer,special purpose computer, or other programmable data processingapparatus (or a combination of devices and circuits) to produce amachine, such that the instructions, which execute via the processor,implement the functions specified in the block or blocks.

These computer-executable instructions may also be stored incomputer-readable memory that can direct a computer or otherprogrammable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablememory result in an article of manufacture including instructions whichimplement the function specified in the flowchart block or blocks. Thecomputer program instructions may also be loaded onto a computer orother programmable data processing apparatus to cause a series ofoperational steps to be performed on the computer or other programmableapparatus to produce a computer implemented process such that theinstructions which execute on the computer or other programmableapparatus provide steps for implementing the functions specified in theflowchart block or blocks.

What have been described above are examples. It is, of course, notpossible to describe every conceivable combination of components ormethodologies, but one of ordinary skill in the art will recognize thatmany further combinations and permutations are possible. Accordingly,the invention is intended to embrace all such alterations,modifications, and variations that fall within the scope of thisapplication, including the appended claims. As used herein, the term“includes” means includes but not limited to, the term “including” meansincluding but not limited to. The term “based on” means based at leastin part on. Additionally, where the disclosure or claims recite “a,”“an,” “a first,” or “another” element, or the equivalent thereof, itshould be interpreted to include one or more than one such element,neither requiring nor excluding two or more such elements.

What is claimed is:
 1. An apparatus comprising: a first housing portioncomprising a test fixture having a base dimensioned and configured tooverlay at least a display screen portion of a computing device, anarrangement of receptacles being formed in the test fixture andconfigured to receive any respective contact members within thereceptacles as to render each of the contact members independentlydetectable by the computing device while each respective contact memberis received in the receptacles, the contact members being separate fromthe test fixture and receivable in any of the respective receptacles, asecond housing portion connected to the first housing portion andconfigured to attach the first housing portion with respect to thedisplay screen portion of the computing device; and a mechanical hingeto rotatably connect the first housing portion with the second housingportion to enable the base to be moved into and out of engagement withthe display screen of the computing device, wherein the hinge forms partof an electrical path interconnecting the first housing portion with anelectrical ground of the computing device.
 2. The apparatus of claim 1,wherein the display screen portion of the computing device includes atouch screen configured to detect each of the contact members whilereceived in the receptacles, while the test fixture overlays the touchscreen and in the absence of contact by a user.
 3. The apparatus ofclaim 1, wherein the second housing portion includes a contact surfaceto mechanically and electrically connect the test fixture with a body ofthe computing device.
 4. The apparatus of claim 1, wherein the hinge isconfigured to provide for rotational movement of the base of the firsthousing portion between a test position in which the base is in anoverlying position with the display screen portion of the computingdevice and a support position in which the base operates as a supportmember to support the base and the computing device.
 5. The apparatus ofclaim 4, wherein the support member is a kickstand and the basecorresponds to the test fixture and includes the receptacles, whichprovide viewing access therethrough to the display screen portion whenthe base is in the overlying position with the display screen portion.6. An apparatus comprising: a first housing portion comprising a testfixture having a base dimensioned and configured to overlay at least adisplay screen portion of a computing device, an arrangement ofreceptacles being formed in the test fixture and configured to receiveany one of a plurality of contact members within the receptacles as torender each of the contact members independently detectable by thecomputing device while each respective contact member is received in thereceptacles, the contact members being separate from the test fixtureand receivable in any of the respective receptacles; a second housingportion connected to the first housing portion and configured to attachthe first housing portion with respect to the display screen portion ofthe computing device; and a mechanical hinge to rotatably connect thefirst housing portion with the second housing portion to enable the baseto be moved into and out of engagement with the display screen of thecomputing device, wherein the base includes electrically conductivematerial coupled to an interior sidewall of each of the receptacles, theelectrically conductive material of the base being electricallyconnected to an electrical ground of the computing device through anelectrical path that includes the hinge and a conducting element thatterminates in a plug that is insertable into an electrical connector ofthe computing device.
 7. The apparatus of claim 1, wherein the secondhousing portion comprises a housing configured to attach to a perimeterportion of the computing device and to enable the base of the firsthousing portion to move into an overlaying contact test position withthe display screen portion of the computing device.
 8. The apparatus ofclaim 1, wherein the arrangement of receptacles comprises atwo-dimensional array of receptacles distributed arranged as rows andcolumns across the test fixture, each of the receptacles in the array ofreceptacles being configured to receive one of the contact memberstherein as to render each of the contact members detectable by thecomputing device.
 9. An apparatus comprising: a first housing portioncomprising a test fixture having a base dimensioned and configured tooverlay at least a display screen portion of a computing device, anarrangement of receptacles being formed in the test fixture andconfigured to receive any one of a plurality of contact members withinthe receptacles as to render each of the contact members independentlydetectable by the computing device while each respective contact memberis received in the receptacles, the contact members being separate fromthe test fixture and receivable in any of the respective receptacles, asecond housing portion configured to attach to a perimeter portion ofthe computing device; a hinge configured to rotatably connect the firsthousing portion to the second housing portion, in which the hinge formspart of an electrical path interconnecting the first housing portionwith an electrical ground of the computing device, wherein thearrangement of receptacles comprises: a first two-dimensional array ofreceptacles distributed arranged as rows and columns across the testfixture, each of the receptacles in the first array of receptacles beingconfigured to receive one of the contact members therein as to rendereach of the contact members detectable by the computing device, and asecond array of receptacles spaced apart from the first array ofreceptacles and located near an edge of the test fixture, the secondarray of receptacles further configured to receive selected contactmembers within the receptacles as to render the selected contact membersdetectable by the computing device while received in the receptacles.10. The apparatus of claim 1, wherein the computing device includes atouch screen interface, the computing device including memory configuredto store instructions corresponding to at least one test module toperform at least one of a neurological or cognitive function test viathe computing device, the computing device to record results data in thememory in response to user interaction with the computing device duringeach test.
 11. The apparatus of claim 1, wherein each of the receptacleshas an inner sidewall surface that includes an electrically conductivematerial adapted to contact a respective contact member when in eachreceptacle.
 12. The apparatus of claim 1, wherein the receptaclesinclude apertures extending completely through the test fixture so thedisplay screen portion is viewable through the receptacles while nocontact member is received in the respective receptacles.